The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Friday, July 01, 2011

100,000 terminally ill Britons 'do not get proper palliative care'

Almost 100,000 terminally ill people do not get proper care, according to a Government review which concluded that a new funding system would save millions of pounds and better serve individuals. A national payment structure would cut variation around the country in what the state pays for and what it does not, and support far more people to be cared for in their own homes, it said.

Experts behind the report say the move could reduce deaths in hospital by up to 60,000 a year by 2021, translating into savings of £180 million annually.

At the moment, the amount primary care trusts (PCTs) in England spend on end-of-life care varies widely, from £186 per patient in one area to £6,213 in another.

Access to services, including round-the-clock nursing care, also depends on where people live.

Far more people die in hospital than wish to, and experts estimate that more than 90,000 people are not having their palliative care needs met.

The Palliative Care Funding Review, ordered by Andrew Lansley, the Health Secretary, last summer, proposes a "fair and transparent" funding system where the money is linked to the individual patient.

Under the scheme, people would receive an initial assessment of their needs, which would then be combined with other factors such as their age and capabilities.

This "needs classification system" would have 25 separate classes (13 for adults and 12 for children), each with its own pot of funding.

The funding would take account of things such as personal care needs, including help with washing and eating, the provision of 24/7 nursing care to support people at home and a co-ordinator to help patients work out their state entitlements as well as access to local charitable services.

At present, some end-of-life care providers are paid regardless of how much work they do, offering poor value for money across the service, the review said.

Meanwhile, 97% of hospices do not receive all the funding they need for the NHS services they provide, and some patients are victims of "rationing" towards the end of the NHS financial year.

These latest proposals would guarantee funding regardless of where patients live and whether they are in a care home, hospital or in their own home.

Thomas Hughes-Hallett, chair of the review and chief executive of Marie Curie Cancer Care, said: "No other country in the world has introduced such a system for both adults and children, so the step is both a bold and necessary one."

Professor Sir Alan Craft, adviser to the review, said: "The Government must act on the recommendations contained in the review because evidence shows us that incentivising the provision of palliative care leads to better outcomes for patients, supports choice and is the most cost effective way of using NHS resources.

"We need to remove the barriers within the current system to enable this to happen."

Between 56% and 65% of adults would like to die at home but only 20% do so, with 55% dying in hospital.

The ageing population and the increased complexity of needs towards the end of life mean 90,000 more people than at present could be dying in institutions by 2030, the review said.

Ciaran Devane, chief executive of Macmillan Cancer Support, said people wanted a choice over where to die.

"Twenty-four hour community nursing services are crucial to the delivery of choice and to the realisation of these ambitious recommendations. "It will be up to the Government to ensure that these services are standard across the country. "We need to see a massive improvement on the 56% of PCTs who currently provide 24-hour community nursing."

Simon Chapman, director of policy and parliamentary affairs at the National Council for Palliative Care, said: "It is vital that the Government acts on the review's recommendations and creates a fair funding mechanism that will ensure people get high quality end of life care where and when they need it.

"We only get one chance to get it right for dying people, which is why it must be a priority to ensure everyone who needs it can access palliative care round the clock."

Susan Munroe, Marie Curie Cancer Care's director of nursing and patient services, said: "Far too many people at the end of their lives are still not getting the care and support they need nor do they know what they are entitled to.

"We welcome the recommendations of the review as the next big step. "We now want to see these recommendations implemented by the Government as a matter of urgency."

No comments:

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here